Endovascular Arterial Embolization in the Treatment of Gastroduodenal Ulcer Bleeding

Abstract

Currently, it is possible to improve the outcome of the treatment of gastroduodenal ulcer bleeding by reducing the mortality, primarily in patients with a persistent high risk of rebleeding against the background of the conservative treatment and high operational risk. Unacceptably high postoperative mortality in high-risk surgical patients reaching 60%, often forces the surgeons to use the conservative treatment for these patients, which often leads to rebleeding, open surgery despite the high risk and unsatisfactory outcome of the treatment. A minimally invasive technique such as transcatheter embolization of the gastric and duodenal arteries in gastrointestinal ulcer bleeding, allowing to affect the source of bleeding by endovascularization with a minimal surgical trauma, made it possible to achieve hemostasis in 60 of 61 patients (98%). Rebleeding after arterial embolization occurred in 3 patients (5%). In 51 patients (85%), endovascular hemostasis was permanent. Additionally, 6 patients (10%) underwent delayed surgery at different times after arterial embolization. Overall mortality in high-risk surgical patients was 9.2% and was not related to arterial embolization, which compares this data favorably with many literary sources. With its impact, arterial embolization with an adhesive composite based on N-butyl-2-cyanoacrylate is an alternative to the surgical treatment of gastroduodenal ulcer bleeding and an operation of choice for high-risk surgical patients.